Overview of the U.S. Health Care Delivery System

Definition & Components of Health Care Delivery Systems (HCDS)

Organization and Structure

Health Care Delivery Systems (HCDS) refer to the organization, structure, and processes involved in delivering health care, including prevention, treatment, and rehabilitation.

• Core Components: Facilities, workforce, medical devices/pharma, education/research, insurance, financing

• Process: Involves a continuum from prevention to treatment to rehabilitation

Characteristics of U.S. Health Care Delivery Systems

Key Features

• Evolved, decentralized, fragmented, mostly private

• High variability in cost/quality; inequitable access

Stakeholders in Health Care

Major Groups

• Direct: Patients, providers, employers, insurers, pharma, government

• Broader: Owners, employees, communities

Health & Determinants

Definition and Influences

• Health: Physical, mental, and social well-being

• Determinants: Genetics, behavior, socioeconomic status, physical environment, access, policy

Access & Acceptable Health Care Delivery Systems

Principles

• Universal access, cost-effective, timely, quality care

Levels of Care

Primary, Secondary, Tertiary

• Primary: First contact, outpatient, prevention/chronic management. Providers: family doctors, nurse practitioners, physician assistants.

• Secondary: Specialist care after referral. Providers: cardiologists, surgeons.

• Tertiary: Complex cases, major hospitals. Providers: neurosurgeons, transplant surgeons.

Levels of Prevention

Prevention Strategies

• Primary: Prevent disease (e.g., vaccines, helmets)

• Secondary: Early detection (e.g., screenings)

• Tertiary: Manage disease (e.g., rehab, insulin therapy)

Care Settings

Types of Facilities

• Inpatient: Overnight stay (e.g., hospital, surgery, hospice)

• Outpatient: No overnight stay (e.g., ED, urgent care, specialty clinics)

Hospitals

Types and Ownership

• Public: Government funded, fewer resources, long waits, less modern equipment

• Private: Owned by for-profit or nonprofit organizations; higher cost, better equipment

• Specialty: Children’s hospitals, psychiatric facilities

Historical Phases of U.S. Health Care

Major Developments

• Pre-industrial: Home care, almshouses, dispensaries

• Post-industrial: Physicians powerful, Flexner Report, licensing, Hill-Burton Act

Health Insurance

Types and Coverage

• Medicare: Elderly insurance

• Medicaid: Low-income insurance

• ACA: Expanded coverage, no denial for preexisting conditions

Unethical History in U.S. Health Care

Examples

• Tuskegee Syphilis Study

• Forced sterilization

• Puerto Rico birth control pill trials

Workforce in Health Care

Key Professions

• Physicians: MD/DO, shortage of primary care, maldistribution

• Nurses: Largest workforce, NP/CNMs/CRNAs

• Public health: Prevention/policy

• Allied health: PT, OT, RT, labs, dietitians

• Behavioral health: Mental health/substance use

• Direct care workers: Frontline

Government Roles in Health Care

Federal, State, and Local

• Federal: Medicare/Medicaid, FDA, CDC, HHS

• State: Licensing, Medicaid admin, insurance regulation

• Local: Health departments, sanitation, clinics

Regulatory Agencies

Oversight and Safety

• CMS: Reimbursement, readmission penalties

• Joint Commission: Accredits hospitals, safety standards

• FDA: Drug/device/food safety

• CDC: Public health surveillance

• OSHA: Worker safety

Healthy People 2030

National Health Goals

• Longer lives, equity, healthy environments, quality of life (QoL)

• Sectors: Education, housing, transport, labor, agriculture

Reducing Disparities

Key Hypotheses

• Service, concordance, trust, professional advocacy